Transanal Laparoscopic TME with Robot-Assisted Abdominal Laparoscopy

Abstract

Transanal total mesorectal excision (taTME) exists as an excellent new technique for sphincter-preserving surgery in the distal rectum. Convergence of this with a minimally invasive approach from above, albeit laparoscopically or robotically, allows for an extension of sphincter preservation and represents the ultimate application of a minimally invasive approach. In this chapter, we will describe a taTME approach using laparoscopy from below. The abdominal portion of the procedure including release of splenic flexure, high ligation of the inferior mesenteric artery and inferior mesenteric vein (IMV), mobilization of the colon, and completion of the TME dissection from above will be described using a robotic technique. Anatomic and technical approaches will be highlighted demonstrating the evolving field of rectal cancer surgery.